Treatment of Extravasation

April 17th, 2011
by reuben in radiology

Treatment of Extravasation

Emergency physicians often manage IV catheter malfunction causing extravasation, which can result in significant tissue necrosis. Hyaluronidase may significantly reduce tissue injury from extravasation by hydrolyzing mucopolysaccharides present in connective tissue. This results in a transient increased permeability of the tissue and subsequently enhances diffusion of liquids through the subcutaneous space. Although the irritating medication is distributed over a wider area, quick absorption minimizes tissue injury.

Hyaluronidase has been shown to reduce the extent of tissue damage following extravasation of parenteral nutrition solutions, radiocontrast media, phenytoin, promethazine, dextrose, mannitol, and the vinca alkaloid chemotherapeutic agents (e.g. vincristine, vinblastine). Hyaluronidase is well tolerated and has been used in neonates as well as adults.

Administration techniques differ, but most sources recommend making a ten-fold dilution of a 150 unit vial of hyaluronidase in NS to provide a concentration of 15 units/ml, then dividing the dose into 0.2 ml subcutaneous injections via a 25 gauge needle in 4-5 different sites along the leading edge of erythema.

Hyaluronidase is most effective if administered within the first 2 hours after an extravasation, however, it may still be beneficial when given up to 12 hours after the event.

(1) Wiegand R, Brown J. Am J Emerg Med 2010;28(2):257.e1-2.
(2) Cochran ST, et al. Acad Radiol 2002;9 Suppl 2:S544-6.
(3) Kuensting LL. J Pediatr Health Care 2010;24(3):184-8.
(4) Sokol DK, et al. J Child Neurol 1998;13(5):246-7.


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Responses to “Treatment of Extravasation”

  1. The FDA has this to say about treating dopamine extravasation:

    To prevent sloughing and necrosis in ischemic areas, the area should be infiltrated as soon as possible with 10 to 15 mL of saline solution containing 5 to 10 mg of Regitine (brand of phentolamine), an adrenergic blocking agent. A syringe with a fine hypodermic needle should be used, and the solution liberally infiltrated throughout the ischemic area. Sympathetic blockade with phentolamine causes immediate and conspicuous local hyperemic changes if the area is infilatrated within 12 hours. Therefore, phentolamine should be given as soon as possible after the extravastation is noted.


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